Study of correlation between stereopsis and retinal nerve fiber layer thickness in cases of glaucoma.

BACKGROUND: Glaucoma is an important and common optic neuropathy characterized by progressive loss of retinal ganglion cells and associated morphological changes to the optic nerve and retinal nerve fiber layer (RNFL). The most common assessment of visual function in glaucoma uses perimetric measurements of visual sensitivity. Only few studies have evaluated the binocular function in patients with glaucoma. This study was taken up to establish the correlation of RNFL thickness, in glaucoma, with near and distance stereopsis. METHODS: This pilot, cross-sectional observational study included 100 diagnosed cases of glaucoma and 100 normal participants as controls, studied over a period of one year. The records of all the participants were checked, and only established cases of glaucoma after fulfilling the inclusion and exclusion criteria were included. Analysis of the RNFL using spectral-domain optical coherence tomography was carried out. All the participants were thereafter evaluated for stereoacuity by near (at 40 inches) and distance (at 3 meter) Randot stereoacuity charts. RESULTS: There was a negative correlation between the RNFL thickness and the absolute value of streoacuity (-0.303 for distance versus -0.101 for near in cases and -0.308 for distance and -0.416 for near in control group), decreasing the actual functional stereoacuity, therefore the cases with lower RNFL thickness had lower stereoacuity both for distance and near, however it was statistically significant only for distance (p=0.002). CONCLUSION: Functional aspects, such as stereoacuity, may also be affected in the glaucoma because of decrease in RNFL thickness. Therefore, binocular status should also be evaluated in cases of glaucoma.

Endothelial corneal transplants: indications, clinical profile and surgical outcomes in a tertiary care hospital.

BACKGROUND: Endothelial keratoplasties have become the surgical procedure of choice over full thickness penetrating keratoplasty for corneal decompensation because of endothelial dysfunction. METHODS: A retrospective data review was performed from February 2016 to April 2017 for all the patients who underwent endothelial keratoplasty in a tertiary care center for Indian Armed Forces. RESULTS: A total of 161 corneal transplants were performed; endothelial keratoplasties accounted for 34 (21.1%) transplants. Most common indication was pseudophakic/aphakic bullous keratopathy followed by Ahmed glaucoma valve-related corneal decompensation and Fuchs' corneal dystrophy, respectively. Mean preoperative corneal thickness was 845.96 ± 106.9 microns. Mean lenticule thickness was 131.55 ± 42.47 microns with microkeratome for descemet stripping automated endothelial keratoplasty (DSAEK) and 174 ± 70.4 microns manually for descemet stripping endothelial keratoplasty (DSEK). Mean preoperative best-corrected visual acuity (BCVA) was 1.65 LogMAR (Snellen equivalent in meters 2/60 approx) which significantly improved to 0.82 LogMAR (Snellen equivalent in meters 6/36 approx) after surgery. In the DSAEK group, BCVA improved from 1.61 to 0.7 LogMAR, whereas in the DSEK group, the visual acuity improved from 1.7 to 0.94 LogMAR at one-month postoperative period. Postoperatively, two patients had graft detachment and had to undergo repeat DSAEK. CONCLUSION: Study results suggest the similar trends in our tertiary care hospital as in other most advanced ophthalmic centers around the world for adoption of newer techniques of lamellar corneal transplants and their outcomes.

Solitary retinal capillary hemangioma with combined retinal detachment- rare presentation.

Objective. To report a rare presentation of solitary retinal capillary hemangioma manifesting with combined retinal detachment as initial presentation and its successful management. Methods. A 35-year-old healthy Indian male presented with combined retinal detachment associated with solitary retinal capillary hemangioma as initial presentation; a clinical entity still not reported in literature. Patient was managed with pars plana vitrectomy combined with retinectomy, endolaser, & silicon oil tamponade with good visual & anatomical recovery. Results. Patient had good clinical outcome with final best-corrected visual acuity (BCVA) of 6/ 24 and well attached retina at last follow-up. Conclusion. Solitary retinal capillary hemangiomas can rarely present with advanced vitreo-retinal complications like combined retinal detachment as initial manifestation that can be effectively managed with skilled & appropriate surgical intervention.

Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion: quantifying efficacy and safety.

PURPOSE: Among the retinal vascular diseases, burden of retinal vein occlusion is most common immediately after diabetic retinopathy. Intravitreal corticosteroids are gaining popularity in managing macular edema (ME) of RVO. Our study compares efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone implant (IVD) over 6 months. METHODS: This comparative, prospective, randomized study on 40 patients of non-ischemic central RVO with significant ME (> 330 µm) of < 3 months duration. Study was done at Army Research Hospital between Sep-2012 and May-2014 in accordance to Helsinki Declaration. IVD group (n = 20) received Ozurdex® while IVTA group (n = 20) received triamcinolone-acetonide (4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24. RESULTS: At 6 months, mean improvement in best corrected visual acuity and retinal thickness (CMT) in the IVD group was 0.43 logmar and 323 µm and in IVTA group was 0.49 logmar and 322 µm respectively. Proportion of patients achieving ≥ 15 letters was about 40% in both groups. IOP rise was significantly higher in IVTA group at 12 and 24 weeks. In IVTA group ≥ 10 mmHg IOP rise was seen in 60% of patients, 41.6% among them had > 35 mmHg and 66% needed combination treatment and failed to reach baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being < 26 mmHg and were easily managed with single agent with IOP reaching baseline by 6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher compared to IVD. Cataract progression and cataract surgeries were required at significantly higher rates in IVTA group. In IVTA group, cataract progression was seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD group, 10% patients had cataract progression while none required surgery at 6 months. Relative risk of cataract progression with IVTA is 3.5 times higher compared to IVD. CONCLUSION: Intravitreal steroids are effective in managing macular edema of retinal vein occlusion, while newer formulation of sustained release dexamethasone implant is significantly safer than IVTA.

Phylogenetic analysis of bovine Theileria spp. isolated in south India.

The objective of the present study is to determine the phylogenetic position of the Theileria organisms in blood of cattle of southern India using molecular tools. Theileria annulata (Namakkal isolate, Tamil Nadu) and three Theileria field isolates (free of T. annulata) from Wayanad, Kerala (Wayanad 1, 2, 3) were used. The small subunit ribosomal RNA (SSU rRNA) and major piroplasm surface protein (MPSP) gene products were cloned, sequenced and the phylogenetic tree constructed. SSU rRNA gene of Wayanad 1 isolate (JQ706077) revealed maximum identity with Theileria velifera or Theileria cervi. The phylogenetic tree constructed based on SSU rRNA genes revealed that Wayanad 1 isolate belonged to a new type which share common ancestor with all the other theilerial species while Wayanad 2 and 3 isolates (JX294459, JX294460) were close to types A and C respectively. Based on MPSP gene sequences, Wayanad 2 and 3 (JQ706078, JX648208) isolates belonged to Type 1 and 3 (Chitose) respectively. When, the previously reported MPSP type 7 is also considered from the same study area, Theileria orientalis types 1, 3 and 7 are observed in south India. SSU rRNA sequence of South Indian T. annulata (JX294461) showed a maximum identity with Asian isolates while the Tams1 merozoite surface antigen (MSA) gene (JX648210) showed maximum identity with north Indian isolate.

Bridelia ferruginea promotes reactive oxygen species detoxification in N-nitrosodiethylamine-treated rats.

This study was aimed at investigating the in vitro and in vivo reactive oxygen species (ROS) scavenging and detoxification potentials of aqueous extract of Bridelia ferruginea (B. ferruginea). Reactive oxygen species scavenging potentials of the aqueous leaf extract of B. ferruginea (0.2-1.0 mg/ml) was investigated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical, superoxide ion, hydrogen peroxide, hydroxyl radical, and ferric ion reducing system. The detoxification of ROS was evaluated in N-nitrosodiethylamine-induced redox imbalance in the liver of rats. B. ferruginea extract at 1.0 mg/ml scavenged the DPPH, superoxide ion, hydrogen peroxide, and hydroxyl radical at 87%, 83%, 92%, and 86%, respectively, it also reduced ferric ion significantly. ROS detoxifying enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase) activities were significantly (p < .05) induced by B. ferruginea. These inductions significantly (p < .05) attenuated the N-nitrosodiethylamine-mediated decrease in ROS detoxifying enzymes and compared favorably with Vitamin C. N-nitrosodiethylamine-mediated elevation in the concentrations of malondialdehyde, conjugated dienes, lipid hydroperoxides, protein carbonyl, and percentage DNA fragmentation were significantly (p < .05) lowered by B. ferruginea extract. Overall, the results of this study show that B. ferruginea leaf extract possess ROS scavenging and detoxification potentials.